Friday, November 5, 2010

The Ambien Alibi

Remedies for insomnia have been around as long as civilization. The Chinese used acupuncture, the Greeks and Egyptians used opium, and Europeans used plants such as mandrake. Many cultures used chamomile and valerian to make sleep-inducing teas.

With the late 19th century came the widespread use, and abuse, of choral hydrate, one of the first mass-produced pharmaceuticals to treat insomnia. In the early 20th century, barbiturates such as pentobarbital and phenobarbital became the insomnia drugs of choice. The 1960s saw the introduction of benzodiazepines, such as valium, and by the end of the decade it seemed that everyone was popping the “little yellow pill,” immortalized in The Rolling Stones’ 1966 song “Mother’s Little Helper.”

Fast forward to the 1990s, when a new drug, zolpidem, was introduced under the brand name Ambien. It falls into a class of non-benzodiazepine “hypnotic” sleep aids. Ambien quickly became the first course treatment for insomnia, prescribed not only by psychiatrists, but internists, pediatricians, and physicians in practically every medical specialty. Touted as a safe, non-addictive sleep aid, doctors thought nothing of prescribing it to patients with mild insomnia, many of whom had never taken a sleep aid before.

Last summer, there was a brief article in Rolling Stone entitled “Welcome to the United States of Ambien” by Rob Sheffield. He addressed how Ambien has become a pop culture phenomenon. Though the medication has been around since the early 1990s, he writes that “only now has it reached its cultural saturation point.” He likens Ambien to LSD in 1969 and Ecstasy in 1989 in that it is “the drug that unlocks the fantasy of the moment.” He writes about many of the activities linked to Ambien, such as sleep-eating, sleep-driving, sleep-shopping, and sleep-blogging. He goes on to write that “every night, you can practically smell the Ambien fog settling over a nation of Zolpidem zombies” and that Ambien “gives you the hallucinatory urge to indulge your most moronic whims.”

I have experienced Ambien’s dangerous effects first hand. I was first prescribed the drug in early 2001, when I as only 15 years old. It was a small dose, and it worked satisfactorily for a while without incident. I was new to sleep aids, so my body responded quickly to the drug and it actually put me to sleep. A couple of years later, my doctor upped the dosage. It was soon after that that I first noticed Ambien’s other effects. By this point I had also tried many other sleep aids and my body didn’t react as quickly as it did when I was younger, so I would take the drug and often stay awake for a while. I started to do and say things with little or no recollection in the morning, and when I could remember what I had done, it was as if it had happened in a dream. Luckily I was safe in my parents’ house at that time, and whenever my mom noticed me acting strangely, she would make sure I promptly got into bed.

I stopped using Ambien sometime during my senior year of high school because it had lost its effectiveness to put me to sleep. When Ambien CR came out while I was in college, I decided to give it another go, in conjunction with another sleep aid, with the hope that it would keep me asleep longer. At first it worked well, but then I began to take the Ambien before I took my other sleep aid. The gap between the two grew wider as I noticed how happy I felt while on Ambien; it was like I was suddenly filled with warmth, all of my troubles melted away, and the universe seemed to open with possibilities. Trouble soon ensued as I would have phone conversations, write emails, and walk around campus while on Ambien. The situation would get worse when sometimes, in my altered state, I would decide to take a second pill. At this point I would no longer be making decisions with my right mind, and I would take yet another pill. Then I would essentially lose control, sometimes taking up to a dozen tablets without consciously knowing it. It was as if I was performing these actions in my sleep.

I could write a novella of my Ambien stories alone. I have done some very embarrassing things, with absolutely no recall for the even the next day. Once, while I was living at home, my mom video-taped my Ambien experience so I could see first-hand how it affected me. My speech was slurred, and though I could put full sentences together, nothing I said made sense in my current setting. I would think I was shopping at a clothing store, and then I would think I was at school, then outside. I was having complete hallucinations, and it was frightening so see it caught on tape as I typed on an invisible computer and used an invisible mouse.

So far, no proper scientific studies have shown a very high incidence of engagement in activities while on the drug with next-morning amnesia. Yet practically every day you can find a current news story about someone driving under the influence of Ambien, and TV networks are full of stories of Ambien-eating and other activities. A recent Taiwanese study showed that only 5.1% of participants had “amnesic sleep-related behavioral problems” while on the medication. Yet anecdotal evidence suggests that this percentage should be much higher. I have to wonder if drug-taking behavior is different in the context of a study. Perhaps participants are more likely to take the drug right before they get into bed—they might follow their instructions perfectly. That simply is not the case in the real world.

I look forward to new studies, perhaps ones that involve surveys administered to long-time Ambien users questioning them about their past experiences, to find the true proportion of people that experience Ambien’s undesirable side effects. It is my opinion that this is a dangerous drug, and I am certain that in coming years it will no longer be a first-course treatment for insomniacs, but rather a last resort.